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What surprised them is that Mayhew wanted the post, arguably one of the most grueling and thankless in state government.

“That is a killer job, and you’re always on the hot seat,” said Gordon Smith, vice president of the Maine Medical Association. “You’ve got not only MaineCare, you’ve got social services, licensing, substance abuse … you’ve got thousands of employees and one giant headache.”

“She stepped out of the frying pan into the fire, and then dumped gas on it,” said Dr. Erik Steele, chief medical officer of Eastern Maine Healthcare Systems.

Mayhew agrees it won’t be an easy job. But she said she also sees it as a big opportunity, the next step in a career that she chose as a young girl in Pittsfield talking politics with her father.

“I’ve been very goal-oriented,” she said. “Just focusing on the next goal and the next challenge.”

Mayhew, 46, is now in charge of the state’s largest and most complex state agency. And her department faces big changes, driven both by budgetary limits and by Gov. Paul LePage, who has promised to reform social welfare programs that many Mainers believe are too generous and expensive.

Mayhew said her goal is to protect the safety net for the most needy and vulnerable by streamlining programs, being creative and making hard choices.

“We have to be very clear that that’s our mission,” she said. “We can’t be all things to all people.”

Mayhew lives in China, a rural town outside of Augusta. Her husband, Ron Reed, runs an antique and used furniture shop there, which allows him to spend time with their two boys, 11 and 16, while Mayhew works long days, seven days a week, learning the new job.

Mayhew grew up in a hard-working and well-known family in Pittsfield. Her mother worked as a nurse’s aide, and her father was a foreman at a local manufacturing company.

Dick Mayhew, her father, also was chairman of the school board and a community leader, and he shared his passion for politics with his daughter. Mayhew remembers her father, a Democrat, taking her to hear Edmund Muskie speak when she was about 4 years old.

“I loved the discussions and the debates from the time I was very young,” she said.

At 14, her family moved to Arkansas to be near her mother’s aging parents. It was a tough move for Mayhew, who became known as “the brain from Maine” and struggled to fit in.

“So, I got involved in local politics,” she said.

She volunteered on Democratic campaigns, putting signs up for Bill Clinton during one of his campaigns for governor and volunteering to help Jimmy Carter’s presidential campaign.

At 17, she became a congressional page and moved, alone, to Washington, D.C. She finished high school there, attending classes in the mornings before going to work in the Capitol, delivering correspondence to lawmakers. High school graduation included a Rose Garden reception with President Reagan, her parents snapping pictures.

She went home to enroll in the University of Arkansas, working summers in the manufacturing plant that her father ran until his death, from lung cancer, when she was 19.

The day after Mayhew received her bachelor’s degree in political science, she drove back to Washington. She had no job, just some names to contact.

She became a legislative aide to U.S. Rep. Bill Alexander, a Democrat from Arkansas. A year later, at 23, she took a job in Atlanta as manager of government relations for Equifax Corp., a consumer credit reporting agency.

Mayhew found her way back to Maine in 1990.

A family friend from Pittsfield, Patrick McGowan, was running for Congress as a Democrat. Mayhew talked to him and, at 25, got the job as his campaign manager.

McGowan lost to Olympia Snowe, the Republican incumbent, by a single percentage point. The unexpectedly close finish boosted Mayhew’s career, as well as that of McGowan, who served in Gov. John Baldacci’s Cabinet and ran unsuccessfully in the Democratic primary for governor last year.

Mayhew helped set up a new lobbying practice in Augusta, advocating for a variety of clients, from physical therapists to the beer and wine industry.

She gradually specialized in health care and, in 1999, became vice president of governmental affairs and communications for the Maine Hospital Association. The association represents the state’s 39 hospitals, each one a major employer in its area. The job made her one of the most influential lobbyists in the State House.

“Legislators are very loyal to their hospitals,” said Smith, of the Maine Medical Association, which represents physicians. Mayhew earned a reputation as straightforward, hardworking and passionate, he said.

The hospital association, for example, helped block a 2003 Baldacci proposal for limits on prices and spending by hospitals and medical providers.

“They didn’t want any cap on spending. It was just ferocious,” said Trish Riley, who led Baldacci’s health reform efforts.

Riley remembers spending long sessions working on the state budget, and Mayhew being there, too.

“She’s a real fighter and a scrapper, and she really represented hospitals diligently,” Riley said.

Mayhew’s job included more than lobbying. She helped coordinate efforts to improve hospital operations, such as an initiative that reduced medical errors, she said.

Mayhew left the hospital association last summer, saying she wanted to take a break and spend time with her family.

But after LePage’s November election, she got a call from Tarren Bragdon, a leader of LePage’s transition team.

She agreed to serve on LePage’s budget transition panel, which led to her appointment as a senior staff adviser on health care and other issues. That she was a Democrat never became an issue, she said.

When LePage named Mayhew as his choice for DHHS commissioner, he also joked about being turned down by other candidates — other women, he said — who didn’t want the job.

For Mayhew, the post offered a far lower wage — the salary range tops out at $134,000 — than her lobbying job with the hospital association, as well as even less time with her family, at least for a while. She wouldn’t say what she earned as a lobbyist, except that it was much more than she earns now.

Former state Sen. Peter Mills, a Republican who ran against LePage in last year’s primary, actively sought the job and had a lot of legislative support. Last week, Mills said that, while he wanted LePage to appoint him, he’s pleased it was Mayhew who ended up with the job.

“We all have a lot of respect for her abilities,” he said. “I thought she was an excellent choice. She will rise to it. She’s going to work her butt off to do it.”

Mills recalled his first encounter with Mayhew, in 1995. She was a young lobbyist giving new members of the Senate an overview of the complex Medicaid system.

“She was a little bit nervous, but nevertheless assertive and persistent and right on the money,” he said. “I’ve never found her to be unprepared.”

While legislators unanimously praise Mayhew’s intelligence and toughness, some Democrats opposed her nomination because of her lack of experience managing people and money.

“She has never managed a budget, and it’s a $3.2 billion budget,” said Sen. Margaret Craven, D-Lewiston, one of three Democrats who opposed Mayhew’s confirmation in committee. “She has 3,500 employees … She’s very smart, but smart isn’t going to do it all the time.”

Mayhew’s role as a hospital lobbyist and her lack of experience with social services and welfare programs also raised concerns.

“I think that is her job — to stand up for the vulnerable people,” Craven said. Craven and others said they worry that Mayhew’s lack of experience will make it harder for her to stand up to political pressures to cut safety net programs.

Mayhew said she is in the process of hiring a new executive team that will include people with budget and management expertise. She also said she is learning the maze of social services. Last week, for example, she visited homeless shelters and other community-based programs in Portland.

Mayhew said both she and LePage are determined to protect vulnerable Mainers as they reform services and reduce costs, she said.

“I believe I have a vision that is very much aligned” with LePage’s, she said.

Mayhew also is known for being direct.

Steele, the chief medical officer of Eastern Maine Healthcare Systems, called her a “smart, friendly pit bull shoved into a size 4 dress” who will continue to be a strong advocate within the administration.

“The woman will say anything to anybody that needs to be said, anything,” Steele said. “She’s polite and professional, but she will go toe to toe with anybody who needs to hear … a dose of reality.”

Steele said he also was surprised when Mayhew took the job, although not for long.

“She was going to slow down a little,” he said. “That said, people like Mary cannot shut their brains off. They never stop thinking about what’s going on.”

n The department’s goals are to protect and enhance the health and well-being of Maine people, promote independence and self-sufficiency and protect and care for people who are unable to care for themselves.

n The department’s bureaus or divisions include Medicaid, or MaineCare; the Maine Center for Disease Control and Prevention; Child and Family Services; Multicultural Affairs; Adult Cognitive and Physical Disability Services; Elder Services; Substance Abuse Services; Adult Mental Health Services; Licensing and Regulatory Services, and the Office of Integrated Access and Support, which oversees public assistance programs.

n The department also operates two psychiatric hospitals: the Riverview Psychiatric Center in Augusta and the Dorothea Dix Psychiatric Center in Bangor.

n The department employs about 3,600 people and has an annual budget of about $3.2 billion, which includes state, federal and other special revenue.

n Twenty-two positions in the department are political appointees; the rest are protected, or nonpolitical.

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